Several years ago, we saw early flares from the opioid crisis in Upper East Tennessee, where an alarming number of babies were being born dependent on pain medications.

We began taking action with community partners in 2013, but it still wasn’t clear just how bad things would get for the people of our state.

At BlueCross, we’ve taken significant steps to help promote safety – and some signs point to hope on the horizon. But the unfortunate truth is: Tennesseans are still dying from opioid addiction in record numbers, even as total prescriptions and dosages have decreased.

Knowing our members received 875,000 opioid prescriptions last year, it’s clear there’s still responsible work to be done. And because any of our family members, friends, colleagues and neighbors could be at risk, we’ve put a lot of thought and collaborative effort into asking, “What’s next?”

For three years, we’ve worked closely with an independent panel of external medical experts from across Tennessee. They’ve helped inform our decision making every step of the way to ensure our decisions are based on identified best practices.

Together we’ve taken a deliberate, gradual approach to changing what we cover so we don’t disrupt our members’ care or throw them into crisis.

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Four-year-old Tyler Hardin holds a toy that once belonged to his mother, Heather, as he visits her grave with his sister and grandparents at Calvary Cemetery in Nashville on Sunday, May 27, 2018. Lacy Atkins / The Tennessean

Braelyn Hardin hugs a headstone as her grandparents pick out a marker for their daughter Heather's grave April 14, 2018, at Schultz Monument Co. in Madison. Heather Baltz, Braelyn's mother, died Feb. 23 of a heart infection doctors believe originated with a contaminated needle used to shoot heroin. Lacy Atkins / The Tennessean

Four-year-old Tyler Hardin holds a picture of his mother, Heather Baltz, at their home in Donelson on May 23, 2017. Heather, 28, died in February after battling an opioid addiction for years. Lacy Atkins / The Tennessean

Heather Baltz picks up her son, Tyler Hardin, to look at himself in the mirror after getting his face painted as Batman during his birthday party at their home in Donelson on Saturday, Nov. 11, 2017. Lacy Atkins / The Tennessean

Mickey Baltz comforts his grandson, Tyler Hardin, 4, as they place a toy that had belonged to Tyler's mother, Heather, on her grave during their weekly visit at Calvary Cemetery in Nashville on Sunday, May 27, 2018. Lacy Atkins / The Tennessean

Tina and Mickey Baltz stand with their grandchildren, Braelyn and Tyler Hardin, as they visit their daughter Heather's grave at Calvary Cemetery in Nashville on March 31, 2018. Lacy Atkins / The Tennessean

Braelyn Hardin reacts as she looks through pictures of her mother at her home in Donelson on March 20, 2018. Heather Baltz died in February at the age of 28 after battling an opioid addiction for years. Lacy Atkins / The Tennessean

Tina Baltz serves cake as grandson Tyler Hardin plays with Chase from "PAW Patrol," a surprise guest at his fourth birthday party, at their home in Donelson on Saturday, Nov. 11, 2017. Lacy Atkins / The Tennessean

We recognize many of our members face the daily reality of chronic pain. And many more have episodic pain crises where pain management is part of a necessary treatment plan. We’re also sensitive to the needs of members undergoing oncology, palliative and end-of-life care, so we always approve prior authorizations for those members.

and putting in safeguards to help protect members against dangerous drug combinations.

Because the potential for addiction increases significantly after just a few days of use, we’re adding a seven-day limit for new short-acting opioid prescriptions. We will also begin requiring a new prior authorization when a short-acting agent is being used for an extended period of time.

Next, we’re replacing OxyContin on our covered drug list with Xtampza and Morphabond. These two drugs use abuse-deterrent formulas, meaning they’re safer and hold less street value. And even though the replacement drugs cost more, we’re keeping member co-pays the same as they were for OxyContin.

Our third change is to reduce the allowed daily limit of opioids, cumulative of any drug combination. We know higher doses lead to higher risks of overdose or death – and higher doses aren’t proven to reduce most pain over the long term.

We’re also adding network providers and benefits to cover acupuncture so members with chronic pain have another treatment option.

Buncombe County, North Carolina's former county manager, Wanda Greene, 67; and assistant county managers Jon Creighton, 66, and Mandy Stone, 59, were indicted Aug. 7, 2018, with a series of federal crimes, including taking bribes and kickbacks from contractors. The cartoonist's homepage, citizen-times.com/voices-views David Cohen, Asheville (N.C.) Citizen-Times

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Finally, we’re adding safeguards to alert clinical teams and providers about inappropriate or dangerous drug combinations. For example, if different physicians prescribed someone a muscle relaxer and an opioid, that person could be at risk for respiratory issues. Both providers would have been making decisions in good faith, but without all the information they needed.

Beyond our clinical efforts, BlueCross has also sought to address this public health crisis by collaborating with charitable organizations across the state. Since 2013, our Health Foundation has invested more than $5.4 million in efforts to provide prevention and treatment support.

Working together with providers and community partners, we can make a meaningful difference in addressing the dangers of opioids. And we’ll keep at it because the lives of our family members, friends, colleagues and neighbors depend on it.